COBRA question

[Elaine]

As you know, within three weeks of finding out my dx, my husband was let go.

COBRA is available to us.

The employer said they will pay our COBRA for two months. Then when my husband confronted them saying, "You need to assure me that what you did had nothing to do with my wife's illness, the boss got real nervous and mumbled something a bout call him if he hadn't found work by Jan 1 and they would pay another three months of COBRA for us.

The company's renew date with the HMO is April 1st. My quesition is this:

While we are on COBRA, does my illness still count toward the employer's risk? Or are we off of their risk since we are COBRA?

I hope this question makes sense.

elaine

[shelliemacs]

Elaine,

I am not sure of the answer, but I would call your states department of health to ask that for a difinitive ruling.

[chloesmom]

Elaine,

You need to check with an official agency, possibly your state's department of insurance, to be sure, but when my husband got laid off and he had COBRA, it was identical coverage as when he was working. It was as if he were still employed in terms of medical benefits.

So, I think it's just that the law insists that the company continue to cover you on their insurance plan, and you may have to pay your own monthly premiums, but they must give you that coverage.

So, yes, I think since the claims are still running thru the company benefits plan, it does count on the company's risk and premiums will adjust accordingly for the company. Just my guess. Get an official ruling on that though.

Why would you care what they had to pay after you're thru with them, if you suspect your husband lost his job because of your health condition???

Cindy

[karen335]

Elaine,

Be careful. My employer said they would pay my insurance and didn't. Thay are NOT obligated to pay your Cobra. If payment is defaulted, you CANNOT be re-instated. I checked on this myself. I am NOT an authority or specialized in insurance. This is only MY experience. Check ALL things out. Don't trust this employer. You told them about your illness and they termed your husband, why wouldn't they term your insurance, you didn't work for them. You are not an Asset to the company and neither is your hubby now. I don't mean to sound negative, only looking out for you...

God Bless and prayers for you

Karen

PS., Please let us know what happens and what you found out.

[Connie B]

I might be missing something here and boy that could be a fact, knowing me! But, what would your diagnosis have to do with them letting your husband go? That doesn't even make sense to me! The insurance is the insurance, and it wouldn't have anything to do with his company or costs to the company. They aren't going to raise the cost to the company because of your illness. Was it a package program? Were others on or in this insurance package? My husbands company isn't going to fire him because of me or the fact that I have cancer. They may fire him because he missed a lot of work for taking care of me, (thank god they didn't) and then that would be shady as well if they did that! But our insurance didn't change because of my cancer and the company didn't pay more because of me having cancer! The company pays a premium for insurance, what ever they agree to a package deal, the company doesn't pay extra because of you. It's the insurance company that pays the bills, not your husbands company. Am I understanding you right? I'm just trying to understand is all.

I agree you better be sure they make the COBRA payments. And that I know of Cobra is just an extention of your insurance for 6 months to one year (how ever long it's set up) after you (or in your case your husband) are released or quit a job. I also agree with Cindy to why would it matter what they pay when your through with them?

The up side to this is: You still have insurance, right? (just trying to put a little light on this for you)

Good luck!

[Ry]

Connie,

I am not sure but this issue must vary from state to state or depend on the type of plan. I have medical insurance for my employees (an HMO)and the premium is the premium, its not figured on how much they have paid out. Yes the premium goes up every year but its not based on loss runs like the worker's compensation insurance is. I don't get it either.

[Snowflake]

Connie,

I'm not sure where your husband works. My employment was not in jeopardy with a diagnosis, I work for a global corporation. Once upon a time, I worked for a small office. Insurance was offered, but it was like applying for life insurance NOW - if I COULD get a new life insurance policy, the premium would be out of this world. A small employer would have the same issue with their "package" for their employees. Too much burden (my insurance company paid out $82000 last year for me) and they'll drop the employer OR raise costs...substantially.

I don't think the three weeks is any coincidence, they had time to "panic", talk amongst themselves, "group panic" and then drop Mr. Elaine due to Elaine's "possible" (remember now, Elaine says they've been careful with charges, etc.) medical expenses...

Elaine, talk to an attorney. Talk to someone "G" men, see if you can get an investigation going - call an investigative reporter... You know what you can and will do...line up your ducks and get goin', girl!

[Connie B]

Thanks Ry, I just wanted to make sure I was on the same page. God knows I can be pages behind!!!! I use to work for an Insurance Company but it's been moons ago. And your right states may be different. Maybe we have other members here that live in Kansas and can shed some light on this being Elaine lives in Kansas. Elaine, maybe if we all clicked our red heels three times we can get this all figured out for you my dear. Wouldn't it be nice if things could be so easy??? Maybe the Wizard has the answer! hehehehe! I'm not making fun of you, just trying to cheer you up a little. I know you have a sense of humor.

[Connie B]

Thanks Becky for reminding me about Small Companies!! I know that a company will eat the cost to some point, but usually that takes time, but your right, it does and can happen. My husband is a Union Pipefitter so we're talking a Large Group plan and complete different ball game.

It's sad that Elaine's husband made a lot of money for that company, yet they can turn around and do this to them for pennies compared to the money Mr. Elaine brought in for that company. Life isn't fair!!! And then the Company Mr. Elaine works for makes mention (under there breath) that they will continue to make the Cobra payments??? hummmm I'm thinking Walleye for dinner here. (fishy, fishy, fishy) They could be digging a ditch for theselves saying things as such.

I agree with Becky, call a couple Attorney's, you have nothing to lose or call the News Media, God knows they are always looking for a good story. It just might help you. You never know?

Good Luck!

[Elaine]

Whew, where to begin........

Kansas state law and all state laws that I know of allow insurance premiums to be raised to cover the risk involved. In Kansas there is a distinction made between different types of small businesses--those with over 100 employees and those with less than 100 employees.

Insurance companies are in business to make money, not to spend more in healthcare than they take-in in premiums.

Kansas law says, if a company has less than 100 employees, the premium can only go up 20 per cent a year. There is no cap for businesses with over 100 employees. Thus, the premiums would raise to cover the full extent of the risk. Let's say I died, would the premium go down ??? I doubt it, but I don't know.

In a very large company, when a handful of people have a serious medical condition, the ratio of well people to sick people is greater and thus the premums aren't effected to the extent that exists in a small company.

I asked the question because I am wondering if it would be hard to prove ADA discrimination if my illness is going to effect their premiums even though my husband is no longer working there.

Or maybe they were betting on my husband finding employment and thus they would get him and me off of their insurance.

Or maybe they did think that my husband would not be able to travel and would thus be less effective. I don't know.

My husband smokes. There were battles in that company already between smokers and non-smokers. Maybe that had something to do with it. Maybe the non-smokers didn't want to pay higher premiums.

The premiums we paid out of pocket for husband and wife were already 45.00 a week. Let's say the premiums went up 50 per cent.

The company which is struggling financially, we know, would pay, I estimate, an additional 200,000 a year in premiums. And each employee would pay another 20.00 a week.

Would this have happened if I had breast cancer?

These are thoughts that go through my mind.

When I finally did go through the HMO in late March, I discussed this with the case manager who did tell me that his company's premiums would likely go up AND that at the time when the premiums offered the company were brought forth, the insurance company COULD tell the employer the reason--and thus at that point the HMO could and probably would disclose my illness.

My husband's company's contract year with the HMO begins April 1 each year.

Ry, prehaps your HMO is a pool of other small organizations and that may be why you say your premiums wouldn't go up.

I hope this answers everyone's questions.

Karen: Thanks for the heads up on them paying the COBRA. I keep telling my husband he better get this in writing, but for some reason he believes them--I don't know why men have such trouble seeing through people, but I had these yahooos figured for skunks a long time ago.

elaine

[Rick]

I actually work for an insurance brokerage in Texas. In Texas, I am quite sure that if the employer is still paying your COBRA then you are still a component of the companies risk and rate factors. Loss runs (number of claims and actual $$ ) are used each year to determine the companies new premiums. We write health insurance for large corporatations across the States and most of them use loss runs when determining the companies premiums per annum. As everyone stated above, make sure the company is actually paying do you dont let the COBRA run out because once this happens any pre-existing conditions wont be covered by any future insurance acquired.

Again, I am in the Information Technology area of the brokerage and dont actually get involved with selling but provide tools to our brokers for use in determining companies(based on employee claims) losses and $$ spent.

[TAnn]

Rick, Elaine,

In Texas, if you have a pre-existing condition an insurance company can not deny you coverage IF you had previous coverage within 63 days. In other words, they give you 63 days and then they don't have to cover you with a pre-existing condition. My health insurance cancelled us with no notice (not just me, but my husbands entire company). I was without insurance for 30 days. We ended up having to get into the Texas Health Risk Pool. It is expensive, but they cover anyone w/pre-existing conditions as long as you have had coverage within 63 days. It is an individual policy.

I don't know if other states offer this type of insurance coverage, it is administered by Blue Cross/Blue Shield and thank goodness my doctor and MD Anderson were covered.

I also became pretty educated in the ERISA laws during this time as the company's insurance was self-funded. Big Mess!

TAnn

[Frank Lamb]

In Pa. I don't know if it's legal or not but if an insured runs up large claims it can cost the Co. more in premiums.(companies will terminate employment & use a diff. reason).

Don't trust what they tell you Elaine-get it in writing.

[ginnyde]

I guess we were very lucky. We had owned a small company and had an Aetna HMO. When Earl was dx'd we were the only 2 left on the plan. It was cheaper to have us on as individuals than as a couple, go figure.

Earl got sick 9/21/04. The only bill I really ever saw was for the 7 days in ICU in Atlantic City - $84000. Before the end of the year he had brain surgery, WBR and chest surgery. Aetna renewed us for 2003 and then again for 2004. I remain on this contract until the end of Dec. Then I go on my parttime employers plan.

At least in PA. the ins. cos do demographic billing. I am a demographic nightmare, although healthy I am an 'old' (YUK) female - the worst demograph.

While our rates went up each year they were not more than the same % from previous years. I have told Aetna that I truly had expected the ins. issues to be a big hassle but actually there were very few problems (they denied Celebrex 3x and Iressa 1x) and I thanked them.

Just my experience. BTW the little co I work for now (32 emp) offers COBRA for 18 mths.

[SDianneB]

COBRA is a continuation of the coverage a person has with an employer. If covered by an employer's group plan, you are eligible for COBRA continuation when you have a "qualifying event" -- such as leaving employment. There are time limits to elect COBRA coverage; it isn't automatic. An employer is under no obligation to pay premiums. Generally, they charge the full premium rate while during employment, the employer may have paid part of your premium for you. They can also charge a 2% admininstrative fee on top of the premium. The maximum amount of time you can continue coverage under COBRA is 18 months; longer if disabled. After 18 months, if continued during the additional 11 months disability period, they can charge 100% of the premiums plus an additional 50%. Spouses & dependents can qualify for 36 months of coverage under some circumstances.

Again, it will depend on if the employer's plan is self-funded (ERISA plan) or if they pay premiums only as to how it effects their bottom line. Either way, employers sometimes want to get risky people off of their plans to keep premium costs in line. Obviously if they have sick people and have an ERISA plan where they are paying claims, they want them off to save the high claims $$.

While on COBRA, you have the same plan -- but not life insurance, disability, etc -- only medical/dental/vision coverage. It costs the employer the same if you are active or on COBRA, except that if you are on COBRA paying premiums, the employer gets his money back from you. If it's a self-funded plan, you are just paying premiums and the employer still has to pay your claims plus whatever fees they pay to have claims processed.

While on COBRA, you have to be offered the same coverage as active employees, including any periods in which you can choose to change your coverage.

Here is a URL where you can get more info about COBRA and what your rights are under continuation coverage:

http://www.cms.hhs.gov/hipaa/hipaa1/cobra/default.asp

Qualified ERISA plans are exempt from most state laws governing medical coverage, so if you have issues with coverage you believe covered by a state law, your employer's plan may be an ERISA plan and exempt from that law. One example is mammography -- many states have adopted laws mandating insurance coverage for routine mammograms. Since state laws don't have jurisdiction over ERISA plans, those plans aren't obligated to provide coverage for mammograms.

If it's an HMO, my guess is that it probably isn't an ERISA plan, as there are very few self-insured HMO's out there. It may be an HMO as part of a larger ERISA plan, but that is also not too common.

ERISA only matters if you have a self-insured plan (it also covers retirement plans), and pertains mostly to coverage. COBRA continuation applies to plans whether they are ERISA plans or not, but only covers employers with 20 employees or more.

It's a confusing mess, but you do have rights with COBRA.

Di